Intellectual impairment and dentistry Flashcards
What are barriers to oral healthcare
user/carer
professional service providers
physical barriers
cultural issues
What is having access to primary care beneficial
proximity relationships may already be established family may attend practice longitudinal care equal opportunity to services
How can we help them get to the surgery
preparation social stories (autism) hospital/health passport pre visit multiple visits with slow progress lease with community disability nurse/team for help
How should you arrange arrival of these patients
time appointment for u and px start of a session - not running late give yourself time best time of day for px take px straight to surgery and limit time spent in waiting room
How can we communicate verbally
speak clearly
ask to repeat info u don’t understand
ask qs that are yes or no
don’t lead px response
allow enough time to communicate
don’t interrupt or finish px sentences
repeat the q if they don’t understand
What are adjuncts to communication
makaton picture boards letter boards talking mats draw write
How can we make the right atmosphere for px
non threatening environment
friendly
acclimatize - multiple visits
consider augmentative techniques - relaxation, music
How should we do the first visit
what can u find out before
keep it simple
building trust and relationships
don’t expect too much
What is useful for examination
access to mouth bedi shield open wide mouth rests toothbrush mirror good light head support but ask for consent
When is clinical holding considered
if failure of other techniques
When should clinical holding take place
if no capacity and it is deemed of benefit - px may present a safety risk to them self or others
if px consnets
unplanned emergency where px at significant risk
always record in notes and justify
What are conditions to look out for in medical history
epilsepy
psychiatric conditions
congenital defects in other systems
When treatment planning what do u want it to b e
indivudal
holistic
realistic
What are risk factors for oral health
poor motor control imbrication of teeth lack of cleansing pouching and limited food clearance mouth breathing medications rewarding
How can we provide tooth brushing advice
explain first good time of day and night wear gloves stand behind person slightly to one side keep brushing systematic encourage px to do as much as possible
What is self injurious behavior
self biting of hands arms lips and tongue
What can self injurious behavior be linked to
CP autism tourettes lesch-nyan syndrome profound neurodisaiblity exaggerated or abnormal oral reflex, habit, pain and/or frustration
What is treatment strategies for self injurious behavior
- symptomatic relief
- reassurance for px, parents and carers with monitoring of the situation
- distraction when SIB observed
- pharmacological tx
- behavioral psychology such as positive reinforcement
- construction of oral appliances
- extraction of specific anterior teeth although this may transfer the SIB to another area of the mouth rather than resolve the behavior
- orthographic surgery to create an open bite and prevent self injurious biting
What can drooling be due to
abnormalities in swallowing difficulties moving saliva to back of thought poor mouth closure jaw instability tongue thrusting
How should drooling be dealt with
techniques designed to improve posture should be implemented
tx should be started with non pharmacological and non surgical methods
there should be careful monitoring for oral complications if surgical or pharmacological tx is carried out
If there is bruxism / NCTSL what can be done
construction of splints may be helpful but success dependent on px compliance
What can NCTSL be due to
grinding
reflux
medications
drinks
What is erosion advice
F mouthwash unless swallowing diffuclites
toothpaste - low brain, acidity, high fluoride, anti-hypersensitivity
brushing delayed after one hour of consuming acidic food and drink
professional application of FV advised
DBA may be of value
reduce or eliminate intake of acidic drinks and fruits or at meal times
chew sugar free gum or eat cheese after acid meal
consider referral
How can we help deal w dry mouth
saliva replacements may be helpful
use of sugar free gum and fluids advised
mouth should be examined regularly
fluoride rinses or high fluoride containing TP is advised
referral to appropriate dental specialist may be required
What can be done about feeding problems
good OH advised
intensive regime followed to prevent oral disease
low foaming toothpaste
use suction toothbrush can be of benefit
therapy should be carried out to try reduce oral defensiveness
What can thickeners used for
dysphagia
prevent aspiration
When are tasters used
for those who take nil by mouth
What does treatment under LA depend on
ability to cooperate
volume of tx
type of tx - is it realistic
behavioral techniques and px management
What are the aims of sedation
include reducing fear and anxiety, augmented pain control, minimizing movement and increasing safety
What are adv and disadvantages of sedation
available in primary care/PDS need for iV access need to maintain airway - keep breathing level of understanding necessary medical status
What is the indication for GA
clear inability to cooperate with provision of dental care using other px management techniques including sedation (or contraindication to sue of sedation)
What does GA require
systematic assessment - full history and consent
ideally seen by dentist who will perform GA
anesthetist assessment prior to tx session
admission protocol
what tx is possible under GA
someone to look after them post op
What are pros of GA
comprehensive care
potentially more controllable environment if medical diseases
opportunity for joint working
aftercare and monitoring - inpatient
What are cons of GA
risk of death, brain damage
need support for 24h post op
organization of procedure
complex restorative dental tx not possible
teeth of dubious prognosis removed - reduce risk of future GA
difficulty working environment
no improvement in coping mechanisms - GA pattern/dependent
What dose safeguarding involve
spectrum of measures with purpose of preventing harm and promoting welfare as well as protecting individuals from harm
What is role of GDP in adult protection
recognize - being able to identify adult at risk
respond - manage acute situation and inform other services as required
record - document and report in detail the info obtained and actions taken
If concerns arise or a disclosure is made to the practitioner, what are the following steps that outline the initial management
remain calm and reassure the individual
seek further info
record info given
inform person of next actions
